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Maternal systemic inflammation during pregnancy may restrict embryo−fetal growth, but the extent of this effect remains poorly established in undernourished populations. In a cohort of 653 maternal−newborn dyads participating in a multi-armed, micronutrient supplementation trial in southern Nepal, we investigated associations between maternal inflammation, assessed by serum α1-acid glycoprotein and C-reactive protein, in the first and third trimesters of pregnancy, and newborn weight, length and head and chest circumferences. Median (IQR) maternal concentrations in α1-acid glycoprotein and C-reactive protein in the first and third trimesters were 0.65 (0.53–0.76) and 0.40 (0.33–0.50) g/l, and 0.56 (0.25–1.54) and 1.07 (0.43–2.32) mg/l, respectively. α1-acid glycoprotein was inversely associated with birth size: weight, length, head circumference and chest circumference were lower by 116 g (P = 2.3 × 10−6), and 0.45 (P = 3.1 × 10−5), 0.18 (P = 0.0191) and 0.48 (P = 1.7 × 10−7) cm, respectively, per 50% increase in α1-acid glycoprotein averaged across both trimesters. Adjustment for maternal age, parity, gestational age, nutritional and socio-economic status and daily micronutrient supplementation failed to alter any association. Serum C-reactive protein concentration was largely unassociated with newborn size. In rural Nepal, birth size was inversely associated with low-grade, chronic inflammation during pregnancy as indicated by serum α1-acid glycoprotein.
Antipseudomonal carbapenems are an important target for antimicrobial stewardship programs. We evaluated the impact of formulary restriction and preauthorization on relative carbapenem use for medical and surgical intensive care units at a large, urban academic medical center using interrupted time-series analysis.
The aim of this study was to estimate the effectiveness of first-line biologic disease modifying drugs(boDMARDs), and their approved biosimilars (bsDMARDs), compared with conventional (csDMARD) treatment, in terms of ACR (American College of Rheumatology) and EULAR (European League against Rheumatism) responses.
Systematic literature search, on eight databases to January 2017, sought ACR and EULAR data from randomized controlled trials (RCTs) of boDMARDs / bsDMARDs (in combination with csDMARDs, or monotherapy). Two adult populations: methotrexate (MTX)-naïve patients with severe active RA; and csDMARD-experienced patients with moderate-to-severe active RA. Network meta-analyses (NMA) were conducted using a Bayesian Markov chain Monte Carlo simulation using a random effects model with a probit link function for ordered categorical.
Forty-six RCTs met the eligibility criteria. In the MTX-naïve severe active RA population, no biosimilar trials meeting the inclusion criteria were identified. MTX plus methylprednisolone (MP) was most likely to achieve the best ACR response. There was insufficient evidence that combination boDMARDs was superior to intensive (two or more) csDMARDs. In the csDMARD-experienced, moderate-to-severe RA population, the greatest effects for ACR responses were associated with tocilizumab (TCZ) monotherapy, and combination therapy (plus MTX) with bsDMARD etanercept (ETN) SB4, boDMARD ETN and TCZ. These treatments also had the greatest effects on EULAR responses. No clear differences were found between the boDMARDs and their bsDMARDs.
In MTX-naïve patients, there was insufficient evidence that combination boDMARDs was superior to two or more csDMARDs. In csDMARD-experienced patients, boDMARDs and bsDMARDs were comparable and all combination boDMARDs / bsDMARDs were superior to single csDMARD.
The development of the unsteady pressure field on the floor of a rectangular cavity was studied at Mach 0.9 using high-frequency pressure-sensitive paint. Power spectral amplitudes at each cavity resonance exhibit a spatial distribution with a streamwise-oscillatory pattern; additional maxima and minima appear as the mode number is increased. This spatial distribution also appears in the propagation velocity of modal pressure disturbances. This behaviour was tied to the superposition of a downstream-propagating shear-layer disturbance and an upstream-propagating acoustic wave of different amplitudes and convection velocities, consistent with the classical Rossiter model. The summation of these waves generates a net downstream-travelling wave whose amplitude and phase velocity are modulated by a fixed envelope within the cavity. This travelling-wave interpretation of the Rossiter model correctly predicts the instantaneous modal pressure behaviour in the cavity. Subtle spanwise variations in the modal pressure behaviour were also observed, which could be attributed to a shift in the resonance pattern as a result of spillage effects at the edges of the finite-width cavity.
The purpose of this study was to quantify the effect of multidrug-resistant (MDR) gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) on mortality following infection, regardless of patient location.
We conducted a retrospective cohort study of patients with an inpatient admission in the US Department of Veterans Affairs (VA) system between October 1, 2007, and November 30, 2010. We constructed multivariate log-binomial regressions to assess the impact of a positive culture on mortality in the 30- and 90-day periods following the first positive culture, using a propensity-score–matched subsample.
Patients identified with positive cultures due to MDR Acinetobacter (n=218), MDR Pseudomonas aeruginosa (n=1,026), and MDR Enterobacteriaceae (n=3,498) were propensity-score matched to 14,591 patients without positive cultures due to these organisms. In addition, 3,471 patients with positive cultures due to MRSA were propensity-score matched to 12,499 patients without positive MRSA cultures. Multidrug-resistant gram-negative bacteria were associated with a significantly elevated risk of mortality both for invasive (RR, 2.32; 95% CI, 1.85–2.92) and noninvasive cultures (RR, 1.33; 95% CI, 1.22–1.44) during the 30-day period. Similarly, patients with MRSA HAIs (RR, 2.77; 95% CI, 2.39–3.21) and colonizations (RR, 1.32; 95% CI, 1.22–1.50) had an increased risk of death at 30 days.
We found that HAIs due to gram-negative bacteria and MRSA conferred significantly elevated 30- and 90-day risks of mortality. This finding held true both for invasive cultures, which are likely to be true infections, and noninvasive infections, which are possibly colonizations.
The isotopic composition of ancient wood has the potential to provide information about past environments. We analyzed the δ13C, δ18O, and δ2H of cellulose of conifer trees from several cross-sections at each of 9 sites around the Great Lakes region ranging from ∼4000 to 14,000 cal BP. Isotopic values of Picea, Pinus, and Thuja species seem interchangeable for δ18O and δ2H comparisons, but Thuja appears distinctly different from the other 2 in its δ13C composition. Isotopic results suggest that the 2 sites of near-Younger Dryas age experienced the coldest conditions, although the Gribben Basin site near the Laurentide ice sheet was relatively dry, whereas the Liverpool site 500 km south was moister. The spatial isotopic variability of 3 of the 4 sites of Two Creeks age shows evidence of an elevation effect, perhaps related to sites farther inland from the Lake Michigan shoreline experiencing warmer daytime growing season temperatures. Thus, despite floristic similarity across sites (wood samples at 7 of the sites being Picea), the isotopes appear to reflect environmental differences that might not be readily evident from a purely floristic interpretation of macrofossil or pollen identification.
High-resolution radiocarbon calibration for the last 14,000 cal yr has been developed in large part using European oaks and pines. Recent subfossil wood collections from the Great Lakes region provide an opportunity to measure 14C activity in decadal series of rings in North America prior to the White Mountains bristlecone record. We developed decadal 14C series from wood at the classic Two Creeks site (∼11,850 BP) in east-central Wisconsin, the Liverpool East site (∼10,250 BP) in northwestern Indiana, and the Gribben Basin site (∼10,000 BP) in the Upper Peninsula of Michigan. Initial AMS dates on holocellulose produced younger-than-expected ages for most Two Creeks subsamples and for a few samples from the other sites, prompting a systematic comparison of chemical pretreatment using 2 samples from each site, and employing holocellulose, AAA-treated holocellulose, alpha-cellulose, and AAA-treated whole wood. The testing could not definitively reveal the source of error in the original analyses, but the “best” original ages together with new AAA-treated holocellulose and α-cellulose ages were visually fitted to the IntCal04 calibration curve at ages of 13,760–13,530 cal BP for the Two Creeks wood, 12,100–12,020 cal BP for Liverpool East, and 11,300–11,170 cal BP for Gribben Basin. The Liverpool East age falls squarely within the Younger Dryas (YD) period, whereas the Gribben Basin age appears to postdate the YD by ∼300 yr, although high scatter in the decadal Gribben Basin results could accommodate an older age nearer the end of the YD.
We use the underlying data of the IMPLAN Pro 3.0 regional economic simulation model to estimate the current economic contribution of Michigan's local food system and explore the chain of transactions giving rise to consumption of locally sourced goods from producer to processor to consumption. The proposed methodology includes both unprocessed and processed foods in the estimation of the local food system's economic value. The model also provides a replicable and consistent approach to estimating the value of local food systems within regional and state economies.
Background: A definitive diagnosis of multiple sclerosis (MS), as distinct from a clinically isolated syndrome, requires one of two conditions: a second clinical attack or particular magnetic resonance imaging (MRI) findings as defined by the McDonald criteria. MRI is also important after a diagnosis is made as a means of monitoring subclinical disease activity. While a standardized protocol for diagnostic and follow-up MRI has been developed by the Consortium of Multiple Sclerosis Centres, acceptance and implementation in Canada have been suboptimal. Methods: To improve diagnosis, monitoring, and management of a clinically isolated syndrome and MS, a Canadian expert panel created consensus recommendations about the appropriate application of the 2010 McDonald criteria in routine practice, strategies to improve adherence to the standardized Consortium of Multiple Sclerosis Centres MRI protocol, and methods for ensuring effective communication among health care practitioners, in particular referring physicians, neurologists, and radiologists. Results: This article presents eight consensus statements developed by the expert panel, along with the rationale underlying the recommendations and commentaries on how to prioritize resource use within the Canadian healthcare system. Conclusions: The expert panel calls on neurologists and radiologists in Canada to incorporate the McDonald criteria, the Consortium of Multiple Sclerosis Centres MRI protocol, and other guidance given in this consensus presentation into their practices. By improving communication and general awareness of best practices for MRI use in MS diagnosis and monitoring, we can improve patient care across Canada by providing timely diagnosis, informed management decisions, and better continuity of care.
This paper examines choices of earth-working tools made by Neolithic Chinese populations. In the Hemudu Culture (7000–5000 B.P.), bone (scapula) digging tools were used from the earliest times, whereas peoples in surrounding areas used stone spades. A range of experiments on manufacturing costs, durability, and use efficiency under realistic conditions show that bone and stone spades are functionally equivalent when soils are soft, but that stone implements provide significant and easily perceived advantages when working harder soils. The persistence of scapular spades in the Hemudu Culture would have constrained decisions about undertaking large construction projects under normal soil conditions. Our results show that, in addition to generalized labor for construction, labor demands for producing earth-working implements for large-scale prehistoric earthworks could have also been substantial. These findings not only help explain the processes of intensifying rice-agriculture and sedentary settlements in the Lower Yangzi Basin, but also create a solid foundation for further investigation of how the recruitment of both generalized and specialized laborers, the organization of craft production, and the relevant logistics for large-scale earthworks may have paralleled concentrations of political power in prehistory.